Risk Factors For Falling

Teaching a patient how to get up after a fall to the floor. That’s one of the most empowering lessons I give as a physical therapist.

Technically, a fall is an unplanned, uncontrolled loss of balance to the floor. What you can plan for is how to get up if this does happen.

Why do people fall?

People fall for a variety of reasons – muscle weakness, loss of joint mobility, dizziness or vertigo, poor vision, inner ear problems, poor coordination, or because of tripping over something.

Am I at risk for falling?

Several risk factors can help predict the likelihood of a fall, with the most severe risk factor being that of a previous fall. Older adults are also at higher risk for falls.

During a physical therapy evaluation or treatment session, when I assess a patient’s fall risks, I consider three main categories.

The first is the visual system. Patients at risk for falling should have, at minimum, an annual eye examination. Why? Balance is very dependent on what is known as the feed forward mechanism. As your eyes scan the environment you are walking through, the nervous system warns the body of any changes in terrain and of objects in your way that will need to be negotiated. If the vision is poor, this feed forward mechanism is adversely affected.

The second system responsible for balance is contained within the inner ear, known as the vestibular system (that’s why you often will see a specialty program listed as balance and fall prevention and vestibular rehabilitation).

This highly complex system contains receptors and fluids that act like a carpenter’s bubble level.  As the head and body move, the nervous system responds to feedback from the inner ear receptors telling your brain where your body is and what muscles to activate in order to stay upright. Balance and vertigo problems can be the result of a dysfunction in this system.

Lastly, I look at the total body sensory system, or “somato-sensory system,” which has receptors located throughout the skin, inside joints, and throughout muscle tissue. This sensory system is responsible for the body’s proprioception, or more plainly put, the body’s awareness of where it is in relation to the environment.

Sensors in the skin on the bottoms of the feet, and sensors in the joints give the brain valuable feedback on terrain and weight displacement. Individuals with a loss of leg and foot sensation, as seen in those with diabetes, may be at a higher risk for falling.

All three of these systems work together to balance the body; and a dysfunction in any one of these systems can dramatically increase the risk of a fall.

Physical therapists are trained to assess fall risks, and can evaluate these three systems responsible for balance.

However, if you do find yourself on the floor you’ll need to know the proper technique in getting up from a fall.

Practicing recovery from a fall is important in decreasing anxieties, decreasing fear, and improving your overall function and safety.

Call today to make your own appointment for a balance and falls risk evaluation, and to learn and practice the appropriate steps needed to safely get up from the floor.


physical therapist

Paul Reed, PT, DPT

Paul Reed, PT, DPT is the Clinical Director for the Tidewater Physical Therapy First Colonial location in Virginia Beach. He earned his Doctor of Physical Therapy from Old Dominion University and joined Tidewater Physical Therapy in 2013. He has also completed several continuing education courses in manual therapy and spinal rehabilitation.